Sars and Public Health in Ontario

Total Page:16

File Type:pdf, Size:1020Kb

Sars and Public Health in Ontario THE SARS COMMISSION INTERIM REPORT SARS AND PUBLIC HEALTH IN ONTARIO The Honourable Mr. Justice Archie Campbell Commissioner April 15, 2004 INTERIM REPORT ♦ SARS AND PUBLIC HEALTH IN ONTARIO Table of Contents Table of Contents Dedication Letter of Transmittal EXECUTIVE SUMMARY................................................................................................................1 1. A Broken System .....................................................................................................................24 2. Reason for Interim Report .....................................................................................................25 3. Hindsight...................................................................................................................................26 4. What Went Right?....................................................................................................................28 5. A Constellation of Problems..................................................................................................30 Problem 1: The Decline of Public Health ...............................................................................32 Problem 2: Lack of Preparedness: The Pandemic Flu Example..........................................37 Problem 3: Lack of Transparency.............................................................................................47 Problem 4: Lack of Provincial Public Health Leadership .....................................................51 Problem 5: Lack of Perceived Independence .........................................................................55 Problem 6: Lack of Public Health Communication Strategy................................................56 Problem 7: Poor Coordination with Federal Government...................................................64 Problem 8: A Dysfunctional Public Health Branch...............................................................72 Problem 9: Lack of Central Public Health Coordination......................................................76 Problem 10: Lack of Central Expertise......................................................................................80 Problem 11: No Established Scientific Backup ........................................................................83 Problem 12: Lack of Laboratory Capacity.................................................................................89 Problem 13: No Provincial Epidemiological Unit....................................................................96 Problem 14: Inadequate Infectious Disease Information Systems ......................................100 Problem 15: Overwhelming and Disorganized Information Demands..............................111 Problem 16: Inadequate Data....................................................................................................114 Problem 17: Duplication of Central Data Systems ................................................................118 Problem 18: Blockages of Vital Information ..........................................................................121 Problem 19: Legal Confusion....................................................................................................126 Problem 20: Public Health Links with Hospitals....................................................................131 Problem 21: Public Health Links with Nurses, Doctors and Others..................................139 Problem 22: Lack of Public Health Surge Capacity: The Toronto Example .....................146 Problem 23: The Case of the Federal Field Epidemiologists ...............................................152 6. Improvements since SARS...................................................................................................156 7. Naylor, Kirby, Walker ...........................................................................................................161 8. Federal-Provincial Cooperation...........................................................................................162 9. Independence and Accountability.......................................................................................163 10. The Public Health Ping-Pong Game ..................................................................................168 11. One Local Funding Problem ...............................................................................................175 12. The Municipalities’ Funding Dilemma ...............................................................................182 13. One Local Story: Parry Sound .............................................................................................183 14. An Ontario Centre for Disease Control.............................................................................186 15. Public Health Restructuring .................................................................................................189 16. Greater Priority for Infectious Disease Control................................................................194 INTERIM REPORT ♦ SARS AND PUBLIC HEALTH IN ONTARIO Table of Contents 17. Central Control over Health Protection.............................................................................200 18. Twenty-one Principles for Reform .....................................................................................206 19. Political Will............................................................................................................................209 APPENDIX A: THE COMMISSION’S ONGOING WORK..............................................211 APPENDIX B: ORDER IN COUNCIL....................................................................................213 APPENDIX C: LETTER OF APPOINTMENT .....................................................................215 APPENDIX D: TERMS OF REFERENCE .............................................................................217 APPENDIX E: THE ECONOMIC IMPACT OF SARS........................................................219 ii INTERIM REPORT ♦ SARS AND PUBLIC HEALTH IN ONTARIO Dedication Dedication This report is dedicated to those who died from SARS, those who suffered from it, those who fought the disease, and all those affected by it. INTERIM REPORT ♦ SARS AND PUBLIC HEALTH IN ONTARIO Letter of Transmittal Letter of Transmittal COMMISSION TO INVESTIGATE 180 Dundas Street West, 22nd Floor Toronto, ON M5G 1Z8 THE INTRODUCTION AND SPREAD OF SARS IN ONTARIO Tel: (416) 212-6878 Fax: (416) 212-6879 Website: www.sarscommission.ca The Honourable Archie Campbell Commissioner April 15, 2004 The Honourable George Smitherman MPP Minister of Health and Long-Term Care 10th Floor Hepburn Block 80 Grosvenor St. Toronto, Ontario M7A 2C4 Dear Mr. Minister: Pursuant to the terms of reference, letter of appointment, and Order-in-Council establishing the independent SARS Commission I submit the attached interim report. Yours truly, Archie Campbell Commissioner INTERIM REPORT ♦ SARS AND PUBLIC HEALTH IN ONTARIO Executive Summary EXECUTIVE SUMMARY A BROKEN SYSTEM SARS showed that Ontario’s public health system is broken and needs to be fixed. Despite the extraordinary efforts of many dedicated individuals and the strength of many local public health units, the overall system proved woefully inadequate. SARS showed Ontario’s central public health system to be unprepared, fragmented, poorly led, uncoordinated, inadequately resourced, professionally impoverished, and generally incapable of discharging its mandate. The SARS crisis exposed deep fault lines in the structure and capacity of Ontario’s public health system. Having regard to these problems, Ontario was fortunate that SARS was ultimately contained without widespread community transmission or further hospital spread, sickness and death. SARS was contained only by the heroic efforts of dedicated front line health care and public health workers and the assistance of extraordinary managers and medical advisors. They did so with little assistance from the central provincial public health system that should have been there to help them. These problems need urgently to be fixed. REASONS FOR INTERIM REPORT The work of this Commission will continue until I am satisfied that the necessary evidence has been reviewed. Because government decisions about fundamental changes in the public health system are clearly imminent, this interim report on the public health lessons of SARS is being issued at this time instead of awaiting the final report. This interim report is based on the evidence examined to date and is not intended as the last word on this aspect of the Commission’s investigation. The fact that the Commission must address public health renewal on an interim basis is not to say it is more important than any other urgent issue such as the safety and protection of health care workers. It is simply a case of timing. The Commission continues to interview health care workers, SARS victims, the families of those who died, and those who fought the outbreak. Their story and the story of SARS will be told in the Commission’s final report. For an update on the Commission’s ongoing work see Appendix A. TWENTY-ONE PRINCIPLES FOR REFORM The lessons of SARS yield 21 principles for public health reform: 1. Public health in Ontario requires a new mandate, new leadership, and new resources. 1 INTERIM REPORT ♦ SARS AND PUBLIC HEALTH IN ONTARIO Executive Summary 2. Ontario public health requires renewal according to the principles recommended in the Naylor,
Recommended publications
  • Pandemic Data Sharing: How the Canadian Constitution Turned Into a Suicide Pact
    Pandemic Data Sharing: How the Canadian Constitution Turned Into a Suicide Pact Amir Attaran & Adam R. Houston “The choice is not between order and liberty. It is between liberty with order and anarchy without either. There is danger that, if the court does not temper its doctrinaire logic with a little practical wisdom, it will convert the constitutional Bill of Rights into a suicide pact.” Justice Robert Jackson in Terminiello v. City of Chicago, 337 U.S. 1 (1949) * * * For decades, public health professionals, scholars, and on multiple occasions the Auditor General of Canada, have raised warnings about Canada’s dysfunctional system of public health data sharing. These warnings have been reiterated in the wake of repeated outbreaks – most prominently SARS in 2003, but also foodborne listeriosis in 2008, and H1N1 influenza in 2009. Every single time, the warnings have been clear that unless Canada better prepares itself for a pandemic, many thousands could die, as when the “Spanish Flu” killed an estimated 55,000 Canadians between 1918 and 1920. Almost exactly a century later, COVID-19 arrived. While SARS killed 44 people in Canada, currently (mid-May 2020) COVID-19 kills several fold that every day. Nor is satisfactory progress being made, for unlike some countries, including very seriously affected ones that promptly reversed the epidemic’s growth, in Canada there is still no reversal after approximately two months of lockdown. Why? There are countless reasons, but legally, the most fundamental problem is that epidemic responses are handicapped by a mythological, schismatic, self-destructive view of federalism, which endures despite being flagrantly wrong.
    [Show full text]
  • Monday, May 25
    MONDAY, MAY 25 14:20 – 15:50 CONCURRENT SESSIONS PHPC Ebola in Canada: What have we learned from this outbreak that we didn’t know before? PLAZA C, SECOND FLOOR MSPC The Ebola virus disease outbreak(s) in West Africa have raised several issues for public health and health care, especially with respect to infection prevention and control in health and other settings. The issues have ranged from world travel policy to personal protective equipment protocols. As with many similar public health events in the past (e.g., SARS, H1N1 influenza), the scientific foundations, valid and relevant surveillance data, estimates of risk and burden, effectiveness of interventions, principles and ethics, priorities and goals should provide the basis for evidence-informed, wise and fair decisions. These decisions may result in reaffirmation or change of policies, programs and practice and often have many consequences, including levels of preparedness and response, resource allocation, protocol changes, and specific education and advice for health practitioners and others working and living in the settings of everyday life. These, in turn, can be expected to affect attitudes and behaviour in society. What have we learned (or should we learn) from this outbreak that we didn’t know (or should have known) before? To address these issues from a knowledge translation perspective, panel members will provide the stimuli for interactive responses from the audience and other members of the panel for what promises to be an engaging and educational event. Learning Objectives: Describe the scientific, practical, political and ethical considerations for policy and program decisions for a low-probability, high- consequence public health event in Canada.
    [Show full text]
  • Public Health in Toronto Committee, and Am a Senior at Westdale Secondary School
    P U B L I C H E A L T H I N T O R O N T O C O M M I T T E E C H A I R S : S O N Y A P A L L A P O T H U & S I M R A N P O W A R # M C H 2 0 2 1 Dear Delegates, Hello, my name is Kate Folsetter! I am honoured to be one of your Academic Directors for Model City Hall 2021. I am a senior at Westdale Secondary School in Hamilton. Next year, I will be attending the University of Ottawa to study Conflict Studies and Human Rights in French Immersion. I am very excited to have been chosen to work at the House of Commons to work as a parliamentary page. I am passionate about psychology, helping others, social issues, human rights and politics. I love to learn languages. I am fluent in French and I am learning Spanish. In my spare time I enjoy being outside, walking my dog Mazie, swimming, doing art, writing spoken word poetry and spending time with my friends. I am part of Westdale’s Model UN delegation, poetry club, and Student Council. I am so excited to be a part of Model City Hall 2021. I first attended Model City Hall in 2018 when I was in Grade 9. I loved getting the opportunity to debate municipal political issues. I am passionate about dismantling the systems of oppression that impact women, LGBTQ2S+ community, People of colour, Indigenous peoples and people with disabilities.
    [Show full text]
  • Postcard from Plaguetown: SARS and the Exoticization of Toronto Carolyn Strange
    12 Postcard from Plaguetown: SARS and the Exoticization of Toronto Carolyn Strange ‘“Bad news travels like the plague. Good news doesn’t travel well”’. While this epigram might have appeared in an advertising or marketing textbook, they were the words a Canadian politician chose to explain why the federal government sponsored a Toronto rock concert in the summer of 2003. As the Senator stated, 3.5 million dollars was a small price to pay for an event held to restore confidence in a city struck by SARS. The virus – first diag- nosed in Toronto in March 2003 – had already claimed 42 lives; interna- tional media coverage of the outbreak had strangled the economy. While public health officials imposed quarantine and isolation measures to combat the spread of SARS bureaucrats and business leaders were equally active, treating the virus as an economic crisis caused by negative publicity. ‘SARSstock’, as locals dubbed the concert, was one of many events pre- scribed to repair and revitalize the city’s image post-SARS. By drawing close to half a million fans with big name musicians, including The Rolling Stones, it provided Canadian and US newspapers and television outlets with a splashy ‘good news’ item. Local media commented that the concert gave Torontonians a much-needed tonic. As the Toronto Star declared, it proved to the world that ‘life and business here rock on’.1 When the World Health Organization (WHO) issued its advisory against ‘unnecessary travel’ to Toronto in April 2003, not only suspected SARS car- riers but the city itself felt borders close around it, cutting off vital flows of traffic to the city.2 It is thus possible to frame the economic consequences of SARS within the longer history of quarantine, cordons sanitaires and their commercial dimensions (as Hooker also argues in Chapter 10).
    [Show full text]
  • Assessment and Planning of the Toronto City Region Food System
    Situatieschets en planning van het SYNTHESIS REPORT voedselsysteem van de ASSESSMENT AND PLANNING OF THE TORONTOstadsregio CITY Utrecht REGION (Nederland) FOOD SYSTEM :: De stadsregio Utrecht :: Wie voedt de stadsregio? De U10 regio (hierna ‘regio Utrecht’) is een netwerk Gegevens over voedselvoorziening zijn schaars van 10 gemeentes: de stad Utrecht en 9 omringende vanwege de sterke exportgerichtheid van de gemeentes. De regio Utrecht heeft een bevolking Nederlandse landbouw. Landelijk is 65% van van ongeveer 730.000 inwoners (2015), met een het geconsumeerde voedsel afkomstig van verwachte groei naar 830.000 in 2030. De stad vormt Nederlandse boeren, maar er is weinig bekend een belangrijk logistiek knooppunt door de ligging in over voedselstromen. Op basis van interviews met het centrum van Nederland. deskundigen en gegevens van de belangrijkste lokale initiatieven voor voedseldistributie, wordt geschat dat de landbouw in de regio Utrecht maximaal 5% van al het geconsumeerde voedsel in de regio levert. De regio Utrecht speelt dus een geringe rol als voedselleverancier aan zijn consumenten. Landbouw in de regio Utrecht bestaat grotendeels uit grasland voor de melkveehouderij. Een kleiner aantal bedrijven produceert fruit, voornamelijk appels en peren, aardappelen, tarwe en suikerbieten. Groente productie is schaars. Landbouw in de regio Utrecht is relatief kleinschalig en kent een vergrijzende boerenbevolking. Het wordt ook gekenmerkt door zijn multifunctionaliteit, waar primaire productie wordt gecombineerd met Bevolkingsdichtheid in de regio Utrecht Landgebruik in de regio Utrecht: grasland vrijetijdsbesteding, natuurbehoud (in rood). Map map 2017 (original data: (licht groen) en akkerbouw (donker groen). en sociale of educatieve zorg voor Basisregistratie Topografie, Kadaster, 2017) kwetsbare groepen. SYNTHESIS REPORT ASSESSMENT AND PLANNING OF THE TORONTO CITY REGION FOOD SYSTEM Authors S.
    [Show full text]
  • 2021-03-15 No Clear Significant Benefit to Lockdowns
    Two minutes with the Justice Centre In other words, locking people down made no difference. No clear, significant Meanwhile in Ontario, one of the province’s former chief medical officers sent an open letter to Premier Doug Ford in benefit to lockdowns January, saying: “Lockdown was never part of our planned pandemic response, nor is it supported by strong science.” March 15, 2021 Dr. Richard Schabas had been Ontario CMO for ten years, and was personally involved with the 2003 SARS crisis, as chief of staff at York Central Hospital. Schabas wrote in support of North York MPP Roman Baber, who had been expelled from the Ontario Conservative caucus after writing to Ford that: “The lockdown isn’t working. It’s causing an avalanche of suicides, overdoses, bankruptcies, divorces and takes an immense toll on children.” Schabas noted Baber had been correct in his criticisms and in his call for an end to the Ontario lockdowns. Lockdowns are said to be necessary to slow the spread of Covid, so that health systems are not overwhelmed. “Lockdowns more lethal than Covid” -Dr. Modry Not everybody agrees the health system is in danger, however. In Alberta a highly qualified cardiovascular surgeon, Sometimes it seems a rational discussion of lockdowns is Dr. Dennis Modry, questioned Premier Kenney’s rationale for beyond Canadians. However, more and more the credible continued lockdowns in a December open letter. “We are voices are confirming what has been suspected from the start: nowhere close to overwhelming our healthcare system. As of Lockdowns don’t work and are actually harmful.
    [Show full text]
  • REACHING NEW HEIGHTS Differentiation and Transformation in Higher Education
    REACHING NEW HEIGHTS Differentiation and transformation in higher education November 2013 0 Table of Contents Introduction .................................................................................................................................................. 2 Supporting differentiation in higher education ............................................................................................ 3 Transforming higher education .................................................................................................................... 5 Collaboration and pathways for students..................................................................................................... 6 1. Expanding college degree programs ..................................................................................................... 6 Three-year college degrees ................................................................................................................... 7 Four-year degree programs .................................................................................................................. 7 Stand-alone nursing degrees ................................................................................................................ 8 Approval process for college degrees ................................................................................................... 9 2. A full continuum of opportunities......................................................................................................... 9
    [Show full text]
  • April 9, 2021 Via Email
    In Ontario, the staff at both the central and regional public health laboratories have been called upon repeatedly in crises over the past decade to perform massive test volumes rapidly for Public Health Units and health care providers. SARS, West Nile, and tuberculosis in Toronto’s hostel system are but a few examples. The ability to rise to these challenges reflects the tremendous effort and dedication of the professional and technical staff within the public health laboratory, not withstanding the chronic and increasingly urgent need to stabilize and strengthen these facilities. Dr. Sheela Basrur, Chief Medical Officer of Health, 20051 April 9, 2021 Via email: [email protected] Hon. Peter Bethlenfalvy President Treasury Board Secretariat Whitney Block, Room 4320, 4th Floor 99 Wellesley St. W Toronto, ON M7A 1W3 Dear Hon. Bethlenfalvy, Re: Exemption under the Protecting a Sustainable Public Sector for Future Generations Act, 2019 for the bargaining unit at Public Health Ontario We write today to respectfully request an exemption for Public Health Ontario (PHO) and OPSEU in accordance with s. 27 of the Protecting a Sustainable Public Sector for Future Generations Act, 2019 (the “Act” or “Bill 124”). 1 Basrur SV. Building the foundation of a strong public health system for Ontarians: 2005 annual report of the Chief Medical Officer of Health to the Ontario Legislative Assembly. Toronto, Ont.: Ministry of Health and Long-Term Care; 2005. Without an exemption, PHO, as an agency under the Crown, is subject to the compensation limits dictated by the Act. An exemption would allow the parties to bargain above 1% total compensation in each year—something that is absolutely vital to maintaining the PHO workforce relative to other major employers of laboratory professionals in the province.
    [Show full text]
  • Green Space and Mental Health Systematic Review
    Green Paths to Mental Health: Understanding How Neighbourhood Income Influences the Effects of Green Space on Mental Health Nadha Hassen December 2016 Wellesley Institute works in research and policy to improve health and health equity in the GTA through action on the social determinants of health. Author Nadha Hassen, Wellesley Junior Fellow 2015-2016 About This Report This paper is a product of the Wellesley Junior Fellowship. It is part two in a three part series of papers within this fellowship project to understand how green spaces influence mental health and well-being. The series includes 1) a theoretical framework, based on a scoping review of reviews, 2) a discussion on how neighbourhood income moderates green space effects on mental health, based on quantitative analysis of existing data; and 3) a community consultations paper, based on a Walk Lab. About the Wellesley Junior Fellowship The Wellesley Junior Fellowship is building the next generation of social policy researchers who will work to advance population health and reduce health inequities in the Greater Toronto Area. The Influence of Green Space on Mental Health | Wellesley Junior Fellowship Report © Wellesley Institute 2016 Copies of this report can be downloaded from www.wellesleyinstitute.com. 10 Alcorn Ave, Suite 300 Toronto, ON, Canada M4V 3B2 416.972.1010 [email protected] TABLE OF COntents Introduction .................................................................................................................................................1
    [Show full text]
  • Ontario-Québec Electricity Collaboration and Interprovincial
    Ontario-Québec electricity collaboration and interprovincial trade barriers: using the Agreement on Internal Trade to promote a more sustainable electricity sector in Canada Zachary D’Onofrio 31 March 2016 A Major Paper submitted to the Faculty of Environmental Studies in partial fulfillment of the requirements for the degree of Master in Environmental Studies, York University, Toronto Ontario, Canada ________________ __________________ Student Signature Supervisor Signature Zachary D’Onofrio Mark Winfield Abstract The purpose of this major paper is to examine the potential for the Agreement on Internal Trade (“AIT”) to facilitate electricity trade between the provinces of Ontario and Québec. The AIT covers a wide range of topics, but its chapter on energy was never completed. The principle objective of this paper is to identify current interprovincial trade barriers in the electricity sector and determine whether the addition of an energy chapter to the AIT would be a viable method of minimizing those barriers. In recent months, importing electricity from Québec has been increasingly recognized as an alternative to building electricity production infrastructure in Ontario. Two recent workshops in Toronto and Montréal identified a number of potential benefits that could be achieved through greater electricity collaboration between the two provinces. These include technical benefits such as greater flexibility and the balancing of intermittent renewable energy resources; economic benefits from a price somewhere between what Québec currently receives for its electricity exports to the Northeastern United States and the price that Ontario is planning to pay for its nuclear refurbishments; and the political opportunity to act cooperatively in demonstrating leadership on the issue of climate change.
    [Show full text]
  • A Histor of the Memories of the Sanctuar Cit in Toronto, Canada
    A history of the memories of the ‘sanctuary city’ in Toronto, Canada Rachel Humphris Working Paper No. 2020/5 September 2020 The Working Papers Series is produced jointly by the Ryerson Centre for Immigration and Settlement (RCIS) and the CERC in Migration and Integration www.ryerson.ca/rcis www.ryerson.ca/cerc-migration i Working Paper No. 2020/5 A history of the memories of the ‘sanctuary city’ in Toronto, Canada Rachel Humphris Queen Mary, University of London Series Editors: Anna Triandafyllidou and Usha George The Working Papers Series is produced jointly by the Ryerson Centre for Immigration and Settlement (RCIS) and the CERC in Migration and Integration at Ryerson University. Working Papers present scholarly research of all disciplines on issues related to immigration and settlement. The purpose is to stimulate discussion and collect feedback. The views expressed by the author(s) do not necessarily reflect those of the RCIS or the CERC. For further information, visit www.ryerson.ca/rcis and www.ryerson.ca/cerc-migration. ISSN: 1929-9915 Creative Commons Attribution-Noncommercial-No Derivative Works 2.5 Canada License R. Humphris Table of Contents Introduction ............................................................................................................................. 1 Methodology ........................................................................................................................... 2 The emergence and location of sanctuary ............................................................................
    [Show full text]
  • June 19, 1967
    June 19, 1967 childhood shows the man, morning shows the day." Milton the Jews, before, during and following the war had to be EDITORIAL reckoned with. The Commission finally brought a recom- mendation to partition Palestine, making two states, Jewish and Arab. The Zionists were jubilant, the Arabs utterly dismayed. The UN General Assembly voted approval of the Commission's recommendation the same year and the Jewish state came into being, May 1948. This writer remembers a dramatic news-cast given by Lowell Thomas the evening of May 15, 1948. In his inimical GOD AND GEOGRAPHY style he emphasized that for the first time in more than 2000 years, there was a state known as Israel. A bloody conflict between the Arabs and Jews followed in 1948. This tragic war resulted in the displacement of 800,000 to one million Arabs. There was another bloody skirmish in 1956. This tiny nation surrounded by 35 to 40 million Arabs LTHOUGH a teenager, vivid memories recall events sur- with more than 600 miles of unfriendly boundary lines to A rounding Jerusalem in 1917. The capture of Jerusalem the east and south and the Mediterranean sea on the by General Allenbey, after being in the possession of west is now threatened with what is termed extinction, Muslims for more than six centuries, was a singular event being driven into the sea. in the early part of the twentieth century. Palestine was then declared a mandated area of the British Empire. At this writing the conflict is raging with the Security Council of the United Nations striving for a cease-fire.
    [Show full text]